Is Shulkin on his way out?

POWER STRUGGLE AT THE VA: Several big veterans groups came out in support of VA Secretary David Shulkin over the weekend, but the fate of the only Obama administration holdover remains unclear, with ramifications for Shulkin’s planned overhaul of the VistA system and many other projects.

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— The VA’s press office has removed Shulkin statements about the IG investigation of this summer's European trip from the VA website, and refers calls about his status to the White House. Late Friday, VA spokesman Curt Cashour announced that Shulkin’s chief of staff Vivieca Simpson Wright, who retired after being named in the affair, had been replaced by a former Trump campaign official, Peter O’Rourke. It’s not clear that Shulkin played a role in the choice. Shulkin himself tells POLITICO he has no plans to resign, but the White House has been curiously silent after a week of uproar at the agency. For more details on the underlying political conflict at the VA, read this POLITICO magazine article.

— The American Legion on Monday said it supported Shulkin: “We believe that the current controversy surrounding the Secretary is part of a larger effort to remove him and install others who would take steps to privatize the services provided to our nation’s heroes.” The VFW called for an end to the “political infighting,” and Joe Chenelly, executive director for AMVETS, told the Military Times there were two distinctly different VAs operating now. “Only one has worked with us, the organizations representing the interests of more than 20 million American veterans,” he said. “I am very troubled that the president seems to be allowing some of his appointees to undermine his cabinet member.”

— Dan Caldwell, spokesman for the Koch Brothers-backed Concerned Veterans of America, told Fox News that Shulkin had “refused to fully admit his mistakes and has decided to create unnecessary distractions within the VA.” It said he was “running out of time to fix this and continuing to try to distract from his own mistakes only makes it harder to fix the VA’s culture.”

— What does this mean to the Cerner acquisition? If Shulkin leaves, could it stop the procurement? After all, if the new secretary wants to dismantle VA’s health care system, why would the need an expensive new electronic health record? We hear that the MITRE report Shulkin commissioned—which was finished earlier this month--did not suggest that the agency should scrap the deal, but wasn’t exactly glowing about its predictions of full interoperability among the VA and DoD Cerner solutions and community health records systems.

VA GETTING A HANDLE ON OPIOIDS?: Opioid prescribing at the VA was down 25 percent in 2016 relative to 2012 levels, according to a review article in the Journal of General Internal Medicine, with long-term use accounting for 83 percent of the reduction. The authors, Taeko Minegishi and Austin Frakt of the Boston Healthcare System, attribute this success to 2009 chronic pain directives and some IT solutions, including the VHA Opioid Safety Initiative, which tracks urine drug screens, incorporates state PDMP data and aims to reduce concurrent benzodiazepine prescribing. A new Stratification Tool for Opioid Risk Mitigation -- a dashboard developed to help identify opioid-prescribed patients at high risk of adverse events – is going on line in the spring, the article says.

FRIENDS OF TEFCA: With comments due today on the ONC’s draft Trusted Exchange Framework and Common Agreement (Tefca), industry officials worry that the document could burden clinicians and health information exchanges, conflict with HIPAA law, and give an unaccountable company the power to oversee data exchange. Most commenters praised the framework’s attempt to create a data sharing pathway as long overdue—but urged ONC to move slowly so it doesn’t plague them with expensive and time-consuming work.

—Several commenters questioned whether the framework contradicts HIPAA privacy statutes. Under HIPAA, providers are instructed to share only the “minimum necessary” patient information, but that term becomes fuzzy when providers seek multiple records, say in a query aimed at improving population health. Read more here.

CALL TO SHARE MORE DATA ON OPIOIDS: The Association for Behavioral Health and Wellness, which represents mental health payers, submitted recommendations to the Senate Finance Committee, which is seeking guidance on the opioid crisis. The group called for the modernization of 42 CFR Part 2 to allow sharing of pertinent information on patients with drug abuse, and for the sharing of PDMP data to health plans. The group also wants Medicare to expand its coverage of evidence-based treatments for opioid use disorder, including methadone.

FIELD OF AI STRUGGLING WITH REPLICATION PROBLEMS: According to a new article in Science, the booming field of artificial intelligence (AI) is grappling with a replication crisis, much like the ones that have afflicted psychology, medicine, and other fields over the past decade. Code alone doesn’t guarantee reproducibility, French computational neuroscientist Nicola Rougier tells the magazine. At a meeting of the Association for the Advancement of Artificial Intelligence earlier this month in New Orleans, scientists said the most basic problem is that researchers often don't share their source code. Odd Erik Gundersen, a Norwegian computer scientist reported that only 6 percent of people who presented 400 algorithms at recent AI conferences shared the code, and only a third shared the data they had tested their algorithms on.

YOEST TO ONDCP?: Charmaine Yoest, the top HHS spokeswoman, is expected to leave the department and may join the White House's office of drug control policy, two people briefed on her plans told Pro's Adam Cancryn. Yoest, a longtime anti-abortion advocate, was tapped by the Trump administration last April to run communications strategy. HHS Secretary Alex Azar is expected to install a replacement in the next several weeks.

FACEBOOK TO STUDY ECONOMIC INEQUALITY: CEO Mark Zuckerberg is cracking open his company's vast trove of user data for a study on economic inequality in the U.S. — the latest sign of his efforts to reckon with divisions in American society that the social network is accused of making worse, reports Pro Tech’s Nancy Scola here. The study is mining social connections among Facebook’s American users to shed light on the growing income disparity in the U.S., where the top 1 percent of households is said to control 40 percent of the country's wealth. Facebook is an incomparably rich source of information for that kind of research: By one estimate, about three of five American adults use the social network. Stanford economist Raj Chetty is leading the research team.

HHS ROLLS BACK LGBT-FRIENDLY POLICIES: The nation's health department is taking steps to dismantle LGBT health initiatives, as political appointees have halted or rolled back regulations intended to protect LGBT workers and patients, removed LGBT-friendly language from documents and reassigned the senior adviser dedicated to LGBT health. A Health Affairs study last year found that many LGBT individuals have less access to care than heterosexuals; in a Harvard-Robert Wood Johnson-NPR survey one in six LGBT individuals reported experiencing discrimination from doctors or at a clinic.

About The Author : Arthur Allen

Arthur Allen is the eHealth editor for POLITICO Pro.

Becoming editor of eHealth at Politico marked Allen’s return to the newsroom after 18 years of solitude (apologies to Gabriel Garcia Marquez). As a freelancer beginning in 1996, he wrote for publications and websites such as The Washington Post, The New York Times, The New Republic, Slate.com, Landscape Architecture, Global Health Matters, Science and Mother Jones. He also wrote three books, the last of which, “The Fantastic Laboratory of Dr. Weigl,” comes out in July 2014 (buy your advance copy now!) Once upon a time, when the hairs on Allen’s head were as numerous as pissants on a melon stalk, he was a wire service reporter. He toiled for The Associated Press for the better part of 13 years, including stints in El Salvador, Mexico and Germany. Allen is married to Margaret Talbot; their son heads off to college soon but for now they still have the company of a teenage daughter with impeccable taste in music and style. During Allen’s non-wage earning hours, he may be found playing pickup basketball, studying Polish, reading 19th century novels, or hunting fruitlessly for morels and other edible mushrooms.